A Report on the Psychological Affects of Overcrowding...

A Report on the Psychological Effects of Overcrowding in Refugee Camps in the West Bank and Gaza Strip

Prepared for the Expert and Advisory Services Fund - International Development Research Centre (IDRC)

This work was carried out with the aid of a grant from the Expert and Advisory Services Fund which is administered by the International Development Research Centre, Ottawa, Canada and financially supported by the Canadian International Development Agency in cooperation with the Department of Foreign Affairs and International Trade.

Overcrowding is a phenomenon characterizing most of the 59 Palestinian refugee camps administered by the United Nations Relief and Works Agency (UNRWA) spread out in the Agency’s five fields of operation, namely: Gaza, the West Bank, Jordan, the Syrian Arab Republic and Lebanon. Almost half of the refugee camps are in the West Bank (19) and Gaza (8) amounting to 27 camps. In Gaza, 437,650 persons or, 54.81% of refugees registered with the Agency live in camps; while in the West Bank there are 153, 380 persons, approximately 27% of the registered population who inhabit UNRWA-administered camps.

Overcrowding is pervasive in most refugee camps and is manifest in the private and public domains. The private spaces of shelters are too small for inhabitants, while the public centers, such as schools and health clinics, are few and understaffed, relative to the population size and therefore are overcrowded. This situation generates social and psychological problems, including violence and physical abuse, especially directed towards women and children; early marriage and divorce, incest, the marginalization of children, women, youth, the disabled and the elderly. Overcrowding is also responsible for stress disorders, depression and anxiety.

This report is based on a visit to refugee camps in the West Bank and Gaza, between the 3^rd and 23^rd of November, 1999. It is a follow-up to Mona Marshy’s literature review on the social and psychological effects of overcrowding in refugee camps in the West Bank and Gaza and in which Marshy recommended a field visit to validate her findings. Consequently, this report is the result of visits to various camps, interviews with various social segments of the refugee community, including visits to their homes and discussions with volunteer community workers and representatives of international governmental organizations (IGOs) and Non-governmental organizations (NGOs). Furthermore, the report assesses the pervasiveness of the effects of overcrowding and provides recommendations as to which areas require the greatest attention. Finally, it is important to emphasize that this report addresses policy-makers and donor countries to help them formulate policies, identify priorities, plan and support relevant projects in refugee camps.

The paper is divided into five main sections. Section II provides a general and brief overview of the camps in the West Bank and Gaza and gives background on the context in which the issue of overcrowding is discussed. The third (III) section deals with the causes of overcrowding, mainly as identified and seen through the eyes of refugees, various individuals and local community leaders and groups who provide services to refugees, as well as the observations of the writer of this report. The fourth (IV) section discusses the main social and psychological effects of overcrowding, the services that are currently provided and the gaps that need to be addressed (For a complete listing of the organizations, their services and addresses, please refer to Marshy’s study). This is followed by a section on priorities and recommendations (V). The last section (VI) summarizes the issues and gives quotes taken during the field interviews, giving a sense of the problem as expressed by refugees and workers in the camps.

The duration of the field visit was twenty days, fifteen of which were spent in the West Bank and five in the Gaza Strip. The camps were heterogeneous in terms of their location, number of inhabitants and administrative status. A number of techniques were used to get an in-depth understanding of the problems of overcrowding. The tools and sources of research included:

(Please refer to Annex I for the names of camps visited and subjects interviewed.)

Refugees and refugee camps are held hostage by history, politics and poverty. As half a century rolled by, refugees continued to live in overcrowded camps, whose legal boundaries have not changed since their establishment. One third of the Palestinian population remains in camps because they do not have the means to live independently. Refugees who acquire the financial means relocate outside camps, and those with some means conduct renovations or expand their shelters; however, the majority of refugees are unable to do either and are in urgent need of support.

Table 1: Increase in Refugee Population By Field and Year ( June )
(see Table 1 at the end of the Report)

	Gaza	West Bank	Lebanon	Jordan	S.A.R.	Grand Total
1999 (a)	798,444	569,741	370,144	1,512,742	374,521	3,625,592
1994	643,600	504,070	338,290	1,193,539	327,288	3,006,787
1990	496,339	414,298	302,049	929,097	280,731	2,422,514
1980	367,995	324,035	226,554	716,372	209,362	1,844,318
1970	311,814	272,692	175,958	506,038	158,717	1,425,219
1960	255,542	-	136,561	613,743	115,043	1,120,889
1950	198,227	-	127,600	506,200	82,194	914,221
(a) Of the registered population 36.9 percent were aged 15 or under, 53.8 percent were between 16 and 59 years of age, and 9.4 percent were aged 60 or older.

Please note that all figures are from UNRWA’s official publications and offices, unless indicated otherwise.

Overcrowding in Palestinian refugee camps is the result of historical, political and socio-economic factors. Refugees and refugee camps are the legacy of the 1948 war. During and consequent to that war, over three-quarters of a million Palestinians were uprooted from hundreds of towns and villages. About a third of the population moved into the refugee camps set up by various voluntary organizations such as the International Committee for the Red Cross (ICRC) . In May 1950, the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) took over relief operations and since then has been providing educational, health and relief and social services to Palestinian refugees. Half a century later, over three and a half million Palestinians are still registered as refugees with UNRWA and approximately 1,120,000 inhabit camps in the West Bank, Gaza, Jordan, Syria and Lebanon.

The political and economic turmoil following the 1967 war had a negative impact on all the inhabitants in the West Bank and Gaza. For three decades, political repression, land confiscation, house demolitions, curfews and high unemployment levels characterized the daily lives of the inhabitants. However, various studies such as that of the Norwegian Studies Institute, FAFO, and the Palestinian Central Bureau of Statistics indicate that poverty levels are generally higher in refugee camps, especially in Gaza. Moreover, refugee camps were prime targets during the Israeli occupation: many camps, such as Dheisheh in Bethlehem and Jabalia in Gaza, were often placed under siege for weeks on end, hindering thousands of workers from reaching their places of work. Similarly, many of the youth were placed under detention and many more lost years of education, as schools and educational institutions were frequently closed down. These factors acted as catalysts in increasing levels of poverty with a ripple effect on overcrowding, in that the vast majority of the inhabitants in camps do not have the means to relocate outside their boundaries.

Most of those employed in refugee camps work as skilled and unskilled seasonal or daily labourers in Israel (mainly in construction) or, in the PNA territories, including Jerusalem. Another segment of the work force runs small enterprises, mechanic and repair shops, retail outlets, etc. There are also many who work in the service sector, primarily as teachers, nurses and cleaners. However, the type of employment depends on the location of the camp. Refugees in Tulkarm camp, for example, work in Natanya, Israel(many in agriculture) because it is close by. In Camp No. 1, on the other hand, which is in Nablus, refugees work in the local institutions of the city, as teachers, clerks, cleaners, etc.

It is difficult to provide a precise figure on unemployment levels. Unofficial figures are usually higher than those estimated by researchers or the local inhabitants. Nevertheless, most studies show that refugee camps have higher rates of unemployment compared to the larger society. After the Palestinian Authority (PA) took over the territories, a small number joined the security forces and worked in various other official institutions and departments. Overall, those employed by the PA represent a small percentage of the camp populations.

Refugees living in camps are not a social class and there is differentiation within and among camps. It is also important to note that camps are not closed communities, rather, relationships extend beyond the legal camp boundaries. There have been many changes in the social relations and cultural lives of refugees as is the case in all societies and communities. Notwithstanding many changes in Palestinian society, generally, refugees have maintained social bonds based on the extended family, the original village and the lineage. One important reason for maintaining these relationships has been the lack of effective institutions to provide the individual with social and economic opportunities and support. Therefore, the family provides an important resource for individual mobility and social security.

The large family size in refugee camps is one of the causes of overcrowding. The average family size according to UNRWA’s statistics as of November 1999, is 4.90 for Gaza and 4.56 for the West Bank. The vast majority of the families visited had 6-12 members in total and older women particularly pride themselves in having many children, especially if they are male, a reflection of the patriarchal structure that still dominates society. According to various analysts there is a trend among the younger generation to have fewer children. Although marriage among cousins is no longer the prevalent pattern, many continue to seek partners within the same clan, kin group, or from the same original village or district. The reproduction of the extended family as an important social unit in society has an impact on dwelling arrangements and social relations. Newly-wed young women often end up living with their in-laws, which in some cases creates or compounds the problems of overcrowding. In addition, many young women marry early, because of social and/or economic pressure from the extended family.

Year	Gaza	West Bank	Grand Total
1999	798,444	576,160	1,374,604
1994	643,600	405,070	1,048,670
1990	496,339	414,298	910,637
1980	367,995	324,035	692,030
1970	311,814	272,692	584,506
1960	255,542	-	255,542
1950	198,227	-	198,227

There are 59 refugee camps within UNRWA’s five fields of operation, most of them established following the 1948 war. Ten of these camps were set up consequent to the 1967 war, six in Jordan and four in Syria. Today, many of the camps include refugees (1948) and displaced (1967) and/or displaced-refugees (1948 and 1967). Over time, the shared history of expulsion and of living in camps, fostered a political culture through which camps became symbols of the Palestinian predicament in general.

As a result of the peace agreements that followed the Declaration of Principles on September 13, 1993, these camps fell within different administrative zones, namely: A, B and C: Palestinian Authority control (A); joint Israeli/Palestinian Central Authority control(B); and Israeli control (C). The "Swiss cheese" effect on the population obstructs movement and creates daily problems. The allocation of different travel permits, identity cards, restrictions and/or privileges hinders the movement of the population from one area to another and constrains them in smaller enclaves which are overcrowded. The legal status of refugee camps has been complicated by the zoning arrangements, especially Shu’fat camp near Jerusalem, whose inhabitants are 1948 refugees registered with UNRWA as well as other refugees including inhabitants from the old-city of Jerusalem. Thus refugees fall under various administrative and authority bodies and the ambiguity surrounding their fate and future, discourages them from relocating outside the camps.

The idea of dismantling refugee camps in Palestinian society, or, implementing large-scale plans, has political ramifications. Historically, large-scale projects have been rejected as associated with resettlement plans and consequently were seen as violating UN Resolution 194 (III) calling for the right of return and/or compensation for refugees. Nevertheless, over time, the combined effect of the increase in the population and the miserable conditions in camps, compelled refugees to conduct improvements in their shelters and to fully utilize the 9 square meter area allocated to each registrant.

A quick glance at any refugee camp today will quickly reveal that almost all the camp area has been built up and occupied. Indeed, once there was no longer space to spread out horizontally, people began to build second and third levels, very often contrary to building regulations set by UNRWA and local host governments. Today, improvement in public utilities, such as water and sewerage networks, renovation of shelters, as well as micro-level projects aimed at enhancing the socio-economic and environmental conditions have become a necessity and a general refugee demand.

	1990		1999
	Camp Population	CAMPS	Camp Population	CAMPS
Jordan	222,972	10	274,816	10
Lebanon	154,533	13	204,999	12
S.A.R.	82,407	10	109,315	10
West Bank	110,010	20	153,380	19
Gaza	271,938	8	437,650	8
Total	841,860	61	1,180,160	59

The legal and administrative restrictions are a major cause for overcrowding, compounded by poverty and the inability of refugee families to purchase land or rent outside the boundaries of camps. Higher costs in real estate, unemployment and political repression over the past few decades have been major causes of overcrowding in refugee camps.

The number of camps in the West Bank and Gaza is 27 or almost half the total number of camps Agency-wide. There are 19 refugee camps in the West Bank and 8 in the Gaza Strip. Most of these are overcrowded, suffer from low standards in living conditions, incomplete and inefficient infrastructures and political and social discrimination.

	West Bank	Gaza
Registered Refugees (RR)	569,741	798,444
RR as % of total estimated population	30.5	78.2
RR as % of total RRs	15.7	22
Existing Camps	19	8
RR in Camps (RRCs)	153,380	437,650
RRCs as % of RRs	26.9	54.8

(RR: Registered Refugees: RRC: Registered Refugees living in Camps)
(a) for a complete listing of camps in the West Bank and Gaza please refer to Annex 1.

The above figures clearly indicate that Gaza has the highest number of refugees living in camps relative to the total registered population, followed by Lebanon. As for the West Bank, it contains the largest number of camps in the Middle East, while Jordan has the largest number of refugees in any field, although most of them live outside refugee camps. Yet, since the establishment of camps, the land areas allocated to refugee camps have not expanded, while the population in camps increased dramatically. The average area density of the refugee population living in camps in the West Bank and Gaza as a whole, is estimated at 37.35 sq. meters per individual. (Marshy: 18)

While "overcrowding" is both a cause and effect, it is possible to delineate the main direct causes of overcrowding in the West Bank and Gaza refugee camps. The causes are very important to take into consideration for policy-makers, donor countries and organizations working with refugees. As budgets allocated for refugees shrink, there is an increased need to examine these causes, in order to implement solutions and projects with long-term impact on the refugee community. In addition, causes and effects are linked and it is difficult sometimes to separate one factor from another, because they are so entangled. One of the effects of overcrowding, for example, is yelling and screaming at children, which has a ripple effect on the ability of children to study. However, these factors have been separated as much as possible to highlight the main issues related to this subject.

It is important to note at the beginning of this section that the causes and effects of overcrowding in the West Bank and Gaza are exacerbated by restrictions on movement imposed by the Israeli authorities. UNRWA vehicles and/or personnel, whether transporting doctors, teachers or sanitation and disposal workers are often denied access to refugee camps. In such cases, garbage collection is weeks overdue, doctors cannot reach patients and students cannot attend vocational schools (especially Gazan students who attend vocational training classes in the West Bank).

In this report, public spaces refer to areas such as streets, schools and other public centres such as health and community centres. In fact, due to overcrowding, almost all spaces become ‘public’. The shelter or the ‘home’ is so close to the neighbors in most cases, that ‘privacy’ or the ‘private domain’ becomes a theoretical construct. In addition, culturally, the dichotomy between the private and public domains are ambiguous. Issues and spaces considered ‘private’ in western societies may be very public in other cultures and vice versa.

*Zone A refers to areas within Palestinian Authority territory, Zone B is under joint Israeli/Palestinian control and zone C is under Israeli control.

Shu’fat Camp: It is estimated that over 4000 people have moved into the camp over the past few years so that they could maintain their residency rights in Jerusalem.

*Although close to Ramallah, Israel considers it as part of ‘Greater Jerusalem’.

Almost 600,000 refugees live in 20,678 dunums, which is the total area for refugee camps in the West Bank and Gaza. As the population began to encroach on every vacant area, sometimes in violation of building regulations, ‘empty’ spaces, once used as playgrounds, or gardens began to disappear, so that today there are hardly any unused spaces.

In addition to the lack of space to build upon horizontally, the infrastructure in many camps, mainly streets and sewerage systems, are below international standards of hygiene and environmental health. In al-Jalazon camp, for example, sewerage networks are non-existent and people use individual septic tanks. This has a ripple effect on the soil, due to the chemical breakdown and experts pointed out this may effect the shelters themselves in the future. Furthermore, the population density places pressure on the existing water supply, electricity and other public utilities. In most of the camps alleyways are often flooded with dirty water, usually from broken and disintegrating sewerage pipes.

Although many of the camp alleyways and streets are paved, there are many that still need paving and/or repair. In Jabalia camp, for example, it is a real problem, because the main streets are not asphalted and in the winter they turn into mud pools. More importantly, many of the shelters are on the same level as the streets, it is therefore not surprising that some shelters are flooded with dirty water in the winter. This situation forces the inhabitants of the shelters to sleep and live in a smaller corner of the house, until the water has been drained out.

As for public services, they are not sufficient, especially garbage disposal and it is not uncommon to see children playing around overflowing disposal garbage bins. Although UNRWA provides regular sanitation and disposal services, the deficit and cutbacks in its budget hinders it from hiring more staff and employees to provide these services to a steadily growing population. Many of these disposal bins are placed in wider streets, at the entrances of camps or in areas making it accessible for collection. These areas are similarly attractive to boys who seek wider areas and spaces to play. Many of the boys (to a lesser extent girls) are seen barefoot playing football and other games, due to lack of other spaces.

With the increase in population, people began to build vertically, second and third levels, usually accommodating sons and their families. As horizontal expansion is no longer possible in the majority of camps, the buildings are rising higher and higher. This situation means that the sun-light never enters into many of these shelters and there is no air ventilation, therefore shelters are very damp in the winter and humid in the summer. In addition to the health dimension, social problems are compounded as shelters push closer to one another and the neighborhood becomes overcrowded with large families, almost nullifying the concept of privacy and creating conflicts over space, children and intrusion. Some streets have become so narrow from over-building that it is sometimes difficult for more than one person to walk through.

The main problem in schools is the occupancy rate per classroom. In fact, Gaza has the highest average rate of occupancy in UNRWA’s five fields of operation. UNRWA’s Commissioner General’s report to the General Assembly 30 July 1998 - 1 June 1999, notes that in Gaza it is 50 pupils per classroom, while in PA schools it is lower although still too high, reaching 43 on average. During the same period Gaza Strip UNRWA schools accommodated 159,892 students in 168 schools in the six-year elementary and three-year preparatory cycles. Many of these are on a double-shift basis. In one year the increase was 6% or 9,023 pupils. In 1998/1999 in the West Bank, UNRWA operated 98 schools, 36 for boys and 46 for girls at the elementary and preparatory levels totalling 51,944 pupils. UNRWA schools in the West Bank in camps are overcrowded compared to schools built outside the camps.

Although UNRWA has been building new schools, these have not been sufficient to meet the requirements of new enrolment. Most of the classrooms are cramped and students sit ‘too close for comfort’, usually on very old furniture and in small classrooms.

Moreover, most of the schools have very small playgrounds, so during the short breaks and between shifts one encounters sometimes two thousand students, one shift leaving school and the other coming in. Also lacking are rooms for meetings, reading, libraries and computer facilities. This situation is de-moralizing for both teachers and students. Teachers similarly complain about not having proper rooms to rest, prepare or meet with other teachers and frustration levels are high.

Daycare centers and nurseries, (nurseries much less than daycare centers) which exist in most camps, are similarly overcrowded and the environment needs improvement in terms of ventilation, the general physical layout, the toys and learning materials, the tools and the level of skills of teachers. Teachers are not always trained, or insufficiently trained in Early Childhood Education. In most refugee camps, these centers hardly meet the needs of the population.

Ill health, a common and pervasive effect of overcrowding, reflects itself in the number of daily visits to UNRWA’s health centers. On average, there are 100 patients per doctor each day and in Gaza it is 118. On some days, doctors report they have seen 150 patients. Doctors also report that due to the large number of patients, they almost never have the time to actually physically check the patient. The procedure is to quickly ask the patient about the symptoms and prescribe medicine, such as an antibiotic. The ratio of one health clinic per 10,000 people remains far below national standards, which are 1 per 5,000. A dentist visits camps twice or at the most three times per week, which is never sufficient for the densely populated camps. Refugees point out, that they have to remain in pain until the day the dentist arrives, otherwise they have to seek private doctors and many cannot afford to pay for private health care.

Similarly, for the disabled, the centers are insufficient. Although there is no comprehensive national census on the incidences of disability, smaller surveys conducted in some refugee camps indicate that people with disabilities constitute approximately 3.5% of the population. These incidences rose in the last two decades, particularly in Lebanon, the West Bank and Gaza, due to armed conflict which caused a significant increase in the number of people with disabilities. The Rehabilitation Center for the Visually Impaired (RCVI) in Gaza has approximately 160 clients including 100 children. However, this is below what is needed. A house- to- house survey identified no less than 1100 disabled refugees in Jabalia camp alone. Overcrowding compounded with insufficient rehabilitation centers, has negative effects on many people with disabilities. Many of the children with disabilities are currently confined to their homes, because either there are no places at rehabilitation centers to absorb them and/or they are not integrated into the regular school programs.

There is usually one Youth Activity Center in each refugee camp. However, they are not all very effective or active and certainly they are not sufficient to accommodate the large populations in the camps. With the exception of a few, these centers respond to the needs of a small percentage of the youth population and are primarily male dominated. Their activities are mostly sports, especially football or ‘soccer’, which excludes young women. Although a few Youth Activity Centers have begun to include women, these remain extremely few. Streets are also places where youth ‘hang out’ a great deal and there is generally a negative stereotype regarding the ‘idle youth’. Youth are blamed for many of the social problems, such as ‘fighting, getting into trouble, delinquency and immoral behavior’.

The reality is that a large number of youth are unemployed and out of school and there are not many avenues to grow and develop. Even vocational schools are sometimes difficult to access, either because children do not meet the requirements, are too poor, or are unable to attend these places due to Israeli-imposed travel restrictions. In many cases, they take the buses and leave to spend time walking around the closest urban centers, such as Ramallah or Nablus. There are insufficient programs and centers for youth to provide sports and social activities, but also learning facilities in computers, arts, theatre and other opportunities.

When camps were first established, children played in the space still available in front of their houses. Often these spaces were gardens with trees and constituted safe places to play. Today, gardens and spaces have disappeared, which means children do not have playgrounds, a vital space where they develop and grow through interacting with other children and playing safely and freely. Most children do not enjoy the simple activity of going down a slide or being pushed in a swing. This is particularly important since over half the population is fourteen years and younger and the fertility rate is one of the highest in the world as Marshy and other studies show over five percent per year. Although organizations such as CIDA have begun to assist in establishing such places, there is still a high demand. These children would all ask visitors to "look around in the camp" and then ask, "where do we play?"

Lack of land area to create new centers and overcrowding means that existing social and cultural clubs are overcrowded and do not meet the requirements of the population. Social restrictions on women and girls have hindered their participation in the few existing clubs and centers. Public libraries, cinemas, theatre and art centers, computer training centers, and affordable family outing places are lacking. Indoor sports are too few to mention or totally absent.

Women complain that men can still go to the coffee shops at any time of the day or night. Indeed many of them go to the urban centers such as Ramallah and might even enjoy sitting with friends in a restaurant there, at least those with the financial means to do so. However, women point out they have no place to go at all. UNRWA’s Women’s Program Center is more active in some camps than in others, such as in Shu’fat camp, however, the majority of women are not participants in the programs offered. A large segment is also socially restricted from joining many community activities, they are home-bound. In any case, women point out that one Women’s Center in refugee camps is again not sufficient to cover the needs of the population and a variety of programs are needed to respond to the needs and culture of the local communities.

The basic social unit of Palestinian society is the family, hence private space here refers mainly to the shelters in which the extended or nuclear family resides.

Overcrowding is also related to the size of shelters housing large families. The size of an average housing unit is 3 by 3 meters. In the West Bank and Gaza, official figures point out that approximately 40% of households have a density of three persons or more per room. In most shelters, there is one room utilized more than others, at one time there might be four to six people in the same room. While the population continues to increase, the small shelters are no longer ‘habitable’, yet poverty hinders most families from improving, renovating, relocating or expanding their habitats. People with some means simply push the camp boundaries by building along and near refugee camps illegally. These were individual initiatives and meant that the family had some means to invest in the materials needed to build houses, if not to buy the land.

There is a large number of shelters which are in bad need of renovation. UNRWA’s Peace Implementation Program budget permitted renovation of a few shelters belonging to refugees enrolled in the Special Hardship Case program. However, the pre-requisites to entitle a family to the SHC program are so restrictive that it leaves out a large number of impoverished refugee families. UNRWA Commissioner General’s report on shelters is indicative of the situation: "It was estimated that some 12,881 SHC families, representing 25 percent of the Agency-wide total and comprising 50,020 persons, still lived in housing that did not meet minimally acceptable standards for structural soundness, hygiene, ventilation and space relative to family size."

A visitor to refugee houses will observe that there is always a room which needs painting, furniture, floor tiles or concrete ceilings. Sometimes, houses have huge holes as families await better financial conditions to install a window or door. In addition, overcrowded and cramped neighborhoods, means that the sun cannot reach many of these homes and the inhabitants suffer from chest problems and humidity related illnesses, such as rheumatism and arthritis. In one case in Gaza, a girl developed a skin disease related to the asbestos in the roof of the shelter. Most of the inhabitants of shelters sleep on mattresses on floors and this is particularly bad for children, when the floors are not cemented or tiled properly. In the winter, things get worse with water leaking into the shelters.

The cultural dimension impacts the way the daily life is practised in the private space. In some of the shelters, there is a room where only male visitors are allowed, which means that women and children are confined into smaller areas. Visits to families where there was more than one wife, showed that small shelters are further divided into sections, so that one wife and her children sleep in one section and the other wife and her family occupies the other. However, this living arrangement is not prevalent and wives of the same man usually do not stay in the same house. The living room is the main room, which is used for several purposes; it is a living area, a place where visitors sit, a sleeping area at night and a place where the family gathers to eat.

Although official figures suggest that the average family size is around 4.5, field observation and the inhabitants of the camp suggest a higher figure. Many of the families visited had ten or more members. The difference in figures is due to the fact that registration figures are based on the nuclear family. However, many of the newlyweds move in with their in-laws and hence there might be more than one nuclear family living in the same house. There are a few smaller families, but these are single parent households, divorcees who in any case end up living with other kin members. The family is an extended one, where there are often three generations living in the same shelter. In addition, newlyweds often begin their marital life by living with the husband’s family, which means that conflicts are not unusual between the wife and the in-laws, sometimes extending to the whole family.

At the very least, each nuclear family houses other members for periods of time and it is cyclical. When married children acquire the means to move out, they usually do so leaving elders behind with younger unmarried brothers and sisters. A return to the parents home occurs in the case of divorce or economic hardship. In other words, the unit which belonged to the parents when they first registered remains as a form of security and final resort for members of the family who do not have the means to become independent. In the case of the refugee community this is a necessity.

Overcrowding in the camps, lack of playgrounds and facilities for youth, adolescents and children means that streets are the primary places for play and interaction with peer groups. However, streets are primarily dominated by boys and male youth. Therefore, one major effect of overcrowding is that female children, adolescents and youth are confined in shelters, while boys and male youth dominate the camp alleyways and streets. Both situations foster carelessness and general low morale.

Schools suffer from overcrowding in classes, small playgrounds and absence of facilities for extra-curricular activities. Physical and verbal abuse of pupils is common and is the predominant form of discipline resulting from the inability of teachers to control large numbers of students, lack of teaching skills and general frustration.

Similarly, health centers are congested, doctors see an average of a hundred patients per day and very often more than that. Many sick people remain without proper care. Women, especially burdened with domestic responsibilities towards the extended family, including the elderly and disabled, suffer from fatigue, depression and anxiety, with no specialists or counseling services to help them. Women, including those who work are socially restricted in their movements, while men enjoy more freedom of movement in public spaces.

In the private domain, shelters are overcrowded due to the large family size. Overcrowding in the shelters and the close proximity of neighbors, nullifies the possibility of any privacy or ‘quiet time’. This has a ripple effect on all the members of the household, including: stress, incest, inability to study, beating of wives and children, quarreling and yelling. Quarreling with neighbors is also common, due to overcrowding.

The lack and/or ineffective community centers catering to the needs of the various segments of society, such as the elderly, the disabled, women and youth, has compounded the problem of overcrowding by limiting the spaces available, mainly to the streets or shelters.

Another effect of overcrowding and poverty is that they encourage early marriage to lighten the burden at home, which means pulling young girls out of school. In many cases, early marriages lead to early divorces. Similarly, many boys drop out of school, so that they can work to help their families financially, or because there is general neglect at home and school of their individual needs.

Boys: While you can see both boys and girls playing in the streets, in reality the streets are a male-dominated space. Girls may play in the street only until they are around nine years of age. For boys, streets have become the main play area for such games as soccer. Many times, such areas are where the garbage bins are collected and where children play barefoot, and this leads to health problems. Since ‘space’ becomes a contested area, boys often fight with one another over who has the right to play in a particular place. Parents complain that street playing pushes their children into delinquent behaviour, such as smoking and in some camps drug abuse (for example, in Shu’fat camp). After-school street gatherings means that there are no other activities in which growing boys can participate, whether they are sports, cultural or social activities, thus limiting their potential. Community responsibility is usually fostered in centers for adolescents and youth, at school and in volunteer work, but these are absent or too few to have a real effect on the majority of youth.

Girls: Girls up to eight or nine years of age may be seen playing near their shelters, but beyond that age they are confined to their homes and usually carry out domestic responsibilities around the house, especially house cleaning and caring for their younger sisters and brothers. Many girls do not leave the camp except to visit relatives who happen to live outside. One of the major complaints made by girls is that the boys are ‘always in the streets’ and that their parents do not ‘allow them to play outside, because there are boys’ and that anyway, ‘boys bother them if they happen to walk in the streets’. Consequently, girls also question, "Where do we go? Where can we play?"

Although men have more social and economic mobility, they also suffer from overcrowding in the camps. Men’s responses to overcrowding reveal that they suffer from the tension caused by the demands of family members and unemployment. Many of them noted they ‘run away to the coffee shops’ in the camp, though there are very few. Refugees also use the overcrowding in coffee shops as an index of unemployment. For example, the more men there are in the coffee shops, the higher the unemployment of men. The pressures and frustration men face due to poverty and in the larger society is often unleashed on women who complain that men are often aggressive, anxious and unable to cope with the demands and responsibilities of making a living. The coffee shops in refugee camps are almost entirely occupied by men, places where men exchange news and socialize with their male friends.

Women spend most of their time in the private space of the house. With the exception of those who work outside of the house for a living, generally, women leave the house only to visit neighbours and relatives. A small percentage of women are active in the public domain and these include women who work in local community organizations. According to a doctor working in a health clinic in one of the camps, it became apparent that some women make appointments to visit clinics so that they have the opportunity to leave the house, socialize and meet up with other women. Generally, women are not allowed much movement. In many cases, the permission of the husband is required. Similarly, girls are restricted from moving about freely. Older and married women have more freedom in this regard than their daughters, especially once they reach adolescence. In conditions of overcrowding, movement is never anonymous, girls and women are targets of gossip and families are protective of their daughters’ reputation. Therefore, adolescent girls do not attend many programs, since parents fear such social taboos. One important effect of overcrowding is that it excludes women further from public spaces, which are primarily dominated by males.

The programs set up for women are only partially successful. In recent years women’s organizations and centers began to spread in refugee camps. Of special significance are women’s community-based centers. Once again, shortfalls and shrinking budgets meant that many of these centers need support and are not able to meet the needs of large populations. Many of the women activists note that they cannot reach many women who are confined at home and are restricted from leaving the homes, even to join women’s centers or to take up training courses. Some women would emphasize that this is the ‘way it is’ and society will not allow them to break away from traditional roles. During the Intifada, the space for their political and social participation in the public arena, opened up. However, after the Intifada, women’s roles were diminished and they were compelled to retreat to the private domain.

Moreover, the economic conditions in the West Bank and Gaza have forced many men to seek work in Israel and they are sometimes away from family for days. Upon their return, they encounter problems, which are related to the conflicting worlds to which they are exposed at the political, social and cultural levels while working in Israel. Women’s narratives reveal that they suffer from changes in how their husbands treat them upon their return, in some cases these different experiences destabilize their relationships at home. There is no study to evaluate the number and effect of husbands leaving their families, either to work in Israel or migrate to other countries.

Women whose husbands have left the home for long periods suffer from high stress levels, due to the massive responsibilities they are left to cope with alone. Such responsibilities include taking care of many children, finding a source of livelihood, because husbands do not always send money back, and taking care of parents and sometimes in-laws. Some women interviewed for this report, noted that their husbands had remarried, had forgotten about them and it had been years since they heard news. This area needs further research, but it is evident that the combined effect of poverty, overcrowding and social restrictions on women causes depression and frustration among women.

Due to overcrowded conditions and the closeness of shelters to one another, the noise levels are usually very high. Men, women and children complain that there is never a ‘moment’s peace’. If the family manages to keep the noise level down, the noise from the neighborhood is heard. This creates stress, especially for the sick, the disabled and students trying to study. Moreover, there is simply no place to be alone or to conduct a ‘personal’ matter without the scrutiny of many others. The lack of privacy leads to social control, enhanced by overcrowding. This affects all members of society.

The shelters are so cramped and literally stuck together, it is almost impossible not to overhear the neighbors. This creates many problems among families in the same neighborhood. Children who play in the streets get into fights and adults are dragged into the conflict. Adults explained that they had to restrict and in a few cases sever relations with the neighbours to ‘protect’ their daughters from the young men living next door. Conflicts sometimes erupt, because the boys next door try to harass the neighbor’s daughters. Overcrowding also means that neighbors fight over simple things like trying to clean one’s home. Dirty water sometimes flows into the neighbor’s house and this also often leads to ‘not so neighborly fights’.

Beating and yelling is a common and observed form of discipline at home and in schools. It is common for parents to beat their children and husbands sometimes beat their wives. Physical abuse against women that is rarely publicized occurs. For example, a woman showed me the marks of physical abuse, but I was told not to publicize it, otherwise her husband will beat her again. In turn, women and men beat their children, a form of venting out their general frustration. For men, it is often their inability to provide their families with basic needs and their demands for certain foods, clothes, etc. For women, it is the burden of responsibilities at home and the lack of space and support.

In schools beating is quite common. Teachers using rulers to beat children is an accepted if illegal practice. There are different justifications including: "Parents want us to discipline their children this way!" "If we do not use the ruler, they do not respect us!" "We were beaten as children and look at us now, we are okay!" "Theory is one thing and practice another!" "How can we discipline children when there are over fifty students in the classrooms?" These were common remarks heard from teachers, social workers and parents in all the camps. This is certainly related if not exclusively attributed to overcrowding in the classrooms, teachers simply do not have the time or the space to apply modern methods of education. In most cases, they themselves are under tremendous stress and are underpaid.

Some children reported being injured by the beating and often they do not tell their parents, fearing that they will be beaten even more. Beating children as a result of the inability to discipline large numbers of pupils in class also leads to humiliation and fosters defeat and the lack of motivation to do better in school, contrary to what teachers claim. Many of the students who are beaten, simply do not want to go to school, some end up dropping out, despite the beatings or because of it. As observed during a field visit in refugee camps, parents actually request that their children be disciplined through beating, because ‘they are not studying’ at home.

The degree to which husbands beat their wives is difficult to assess as is the case with some of these socially sensitive issues. Many women refuse to talk about this, fearing the repercussions and more violence against them from husbands, fathers and brothers. However, many of women’s narratives, collected for this report and in other studies, revealed that they had been victims of physical abuse and violence, ranging from a ‘light’ beating to physical abuse leaving scars and injuries. Field observation shows that overcrowding is certainly related to violence against women, in the sense that it creates frustration, but it is not the only factor.

In turn, both men and women beat children. Women, confined to small spaces at home, restricted from leaving their shelters also beat their children. Screaming babies, children demanding to be fed, other children fighting with one another, poverty and social pressure, often express themselves in anger vented on the less powerful in society and children are victims of such abuse.

Many women suffer from depression and high anxiety levels, especially women who have many children, are not working and whose husbands are absent for long periods. There are many women who have problems at home with their husbands, but do not have the social support networks to deal with these problems. Such problems include psychological and physical abuse by husbands and other members of the extended family.

As explained in an earlier section, overcrowding reflects itself in the health centers and the ratio of health staff to patients. In the area of health women are especially vulnerable, because many of the stresses they face in their daily lives turn into depression, often with physical symptoms, but there is never the time for doctors, specialists and counsellors to deal with these cases. Interviews with women and community workers indicated that many women suffer from severe depression and many are given medication to which they get addicted. Some women are not very aware of the side-effects of the pills they are prescribed.

One important reason for women’s depression is the large responsibility placed upon their shoulders. It is the mothers who take care of the physical and social needs of several members of the family, which may include many children, in-laws, the elderly and if there is a disabled member, it is also the mother who feeds, cleans and conducts the daily chores. I met a few women who were divorced, or whose husbands were absent from the home for extended periods of time. These women had to ensure that there was always food on the table, that the children were clothed, etc. but they also had to take the parents or in-laws to doctors, cook and carry food to their relatives and in many cases with very little money. Thus, the constant pressure and unrelenting responsibilities with little support, except from unmarried daughters, leads to high levels of depression and anxiety.

Youth is another segment of society suffering from depression. Their role during the Intifada, during which they were rendered ‘heroes’ empowered them and provided them with authority in their families and communities. The imprisonment of youth was viewed as a certification of their power and the necessary sacrifice for the ‘nation.’ However, the individual suffering and fear of the experience of imprisonment, repression and often torture in prisons, resulted in the loss of years of education and self-development that is suppressed and neglected.

Youth are seeking their new position in the changing political and social environment. Indeed, many parents and adults express that the ‘Intifada’ was responsible for the ‘lost youth.’ Today, youth are seen to overcrowd street corners, and ‘disrupt’ society; they are viewed as being irresponsible and careless. The youth feel this transformation in society of their position from ‘heroes’ to ‘hooligans’ as they put it. They had lost their role and feel there is a void in their lives, with no real prospects for the future. Many were unable to pick up were they left off prior to the Intifada and turned to work in Israel, some joined the security forces in the PNA, others are unemployed and have turned to drugs and drinking. In some families, the repression in prison made the sons turn their anger and aggression against their families and community. This aggression manifests itself in beating up sisters or younger brothers, fighting in the streets and getting into trouble with others. Youth also occupy and move in overcrowded spaces, which are limited in scope and opportunities to develop.

The whole refugee community suffers from general depression in the sense that their expectations of the peace process were much higher than what has actually changed since the PNA relocated to Gaza and the West Bank. High unemployment rates, poverty and the belief that the ‘outsiders from Tunis’ took over political power and authority, to which they were entitled adds to a sense of disappointment and uncertainty regarding their future.

The stress created in the family and household due to the physical presence of six, ten or twelve members (sometimes more) in a small shelter, creates conflict between parents and children, children among one another, in-laws and relatives, which manifests itself in screaming, beating and ostracizing. It is not uncommon for daughters-in-law to fight with parents-in-law and end up returning to their parent’s homes for periods at a time. In the streets and schools, peers fight among one another for the same reasons. Space is very limited and many camp inhabitants attempt to create private corners to do ‘one’s own business’ in private, whether it is playing, studying or just interacting with others.

Neighbors, as indicated earlier also have to co-exist in increasingly narrow spaces, where the walls that separate them are the only boundaries distinguishing one family from the next. In addition, the generational gap between grandparents, parents and children and the changing world views enhances such. Grandparents and parents alike are critical of children, telling them how things were and should be. This is compounded by the lack of space for the youth and children to grow and develop their own ideas. This increases the tension at home and leads to family quarrels.

Many of the quarrels among neighours are due to the need to expand the shelters. In many cases, expanding the shelter or building another room encroaches on, and is done at the expense of, the neighbor’s privacy and sometimes in violation of building regulations. Consequently, conflicts emerge as to who has a just case. Is it the neighbor whose family has grown so much and needs an extra room, or, the neighbor who is affected by the new expansion in a way that obstructs the sun, proper ventilation and privacy?

According to refugees and social workers, early marriage is not decreasing. Many girls are married at fourteen and fifteen years of age. In another field study, this emerged as a source of anxiety to many girls, who sometimes do not have a choice and in poorer families are forced to leave school in order to marry. There are social and economic reasons for this practice. Socially, early marriage is an acceptable practice, inherited from the older generations, where mothers and grandmothers were also married off very young. Although the younger generation looks negatively at early marriage, economic prerogatives come into play and this practice is repeated in the younger generation. The cultural discourse encouraging early marriage is poverty. Marrying young girls early means one ‘less mouth to feed’ and more space at home. Adults noted that the conservative environment in camps encourages parents to marry off their children, especially daughters as soon as they can to ensure that ‘she or he does not get into trouble,’ or in the case of girls, that she is ‘not too old’ as some put it. In the case of boys in poorer families, especially those who receive assistance from UNRWA under the Special Hardship Cases program, many are encouraged to marry before they turn 18, so that the family does not lose rations and/or assistance from the Agency.

Families with six or more children of varying ages cramped in one or two rooms find it almost impossible to provide attention to all the children and follow up on each child’s work at school. Some parents are themselves illiterate and hence cannot provide support at that level. For some parents, education is not an urgent priority in their world view, especially for girls, who are expected to get married. Education in their perspective may be an obstacle, rather than an asset. This problem is mirrored in schools. With overcrowded classrooms, teachers are stressed and can hardly manage to go through the required curriculum, much less to pay attention to the individual needs of their students.

Therefore, students who need special encouragement or assistance from the school system do not find such support and opt to drop out. Others simply are enticed by work opportunities while in grade eight or nine and prefer to work in Israel, the PA or other local institutions to obtain pocket money, which parents are unable to provide. Many parents complain that their sons are creating problems at home, because they want to drop out of school. Other students want to drop out without getting a skill or seeking alternative educational courses. Finally, there is simply no place to concentrate and study. The shelters are filled with noise and there is no space where students can sit and work. In cases where parents are able to maintain a ‘quiet’ household for children to study, the noise in the streets drowns the silence within.

In the classroom, the duration for each subject is 45 minutes and teachers are eager to cover the required material. Consequently, teachers find it hard to allow for class participation, as the time allocated is not sufficient to allow so many students’ active participation or expression of ideas. Teachers have little time outside the classroom to provide counseling or individual interaction. Thus, students, especially teenagers, find that no one has the time for them either at school or at home. Therefore, overcrowding in school and home discourages students from doing well and some end up dropping out. Officially, drop out rates

Dropping out of school at grade nine is not uncommon among girls. UNRWA schools do not provide secondary education and once they graduate many girls are not encouraged to continue with secondary schools. The reason is usually that parents do not have the means to spend money on transportation and other school expenses for all children. Generally, parents would rather spend the money for school on boys than on girls. In addition, many of the parents interviewed expressed their unwillingness to allow their daughters to take public buses and go outside the camp, even for the purpose of studying fearing ‘gossip’ and ‘slander’ from the larger community. Consequently, the incidence of girls being pulled out before completing secondary levels is high and many get married even before they turn eighteen.

One important effect of overcrowding is neglect, especially for the most vulnerable in society. Centers for the disabled are limited and many of the volunteers in refugee camps, mainly community members, are not trained professionally to deal with the disabled, as is the case in Shu’fat camp. The disabled, especially children, suffer from neglect because there are not enough centers and poverty hinders families from sending them to private rehabilitation centers. There are often too many children at home to leave time for adequate attention to the disabled member of the family. In addition, lack of sufficient awareness about disability in the community, reflects itself in neglect and sometimes the marginalization of the disabled. In fact, in some cases, parents do not like to publicize they have disabled children. Some of these children are taken out from the school system and stay at home with no proper care or therapy. In most cases this exacerbates their condition.

As mentioned earlier, overcrowding, poverty and large families lead to neglect. Parents do not have time to pay attention to the individual needs of children. Pressures to procure their daily bread marginalize children and often push male sons to work too early or, while still in school. Both at home and school, the problems of children and adolescents are left unattended. This is most apparent among adolescent girls who complain there is no one ‘who listens or cares for them, instead everyone ‘yells.’

Thus, for young girls, the space in school playgrounds are places where they socialize with their peer groups and an avenue to talk about their problems to their friends. Even then, if they stay too long after school in the playground, they are literally ‘kicked out’ and ordered to go home. This generates a sense of frustration, fear and anxiety, especially among girls with a difficult home life. For example, some are forced to marry early or are beaten by older brothers or parents.

In general, the elderly live with one of the sons, usually the eldest. In overcrowded conditions, the elderly live together with the members of the son’s family, sometimes with other unmarried brothers. The responsibility for tending to the needs of the elderly falls on the shoulder of the daughter-in-law when the son is married, or with the daughters if there are no unmarried sons. However, daughters-in-law have their own family to care for and hence cannot always attend to the needs of the elderly. The situation is stressful for both generations, as daughters-in-law feel they are squeezed between the younger dependent children and the elderly people living in the house. Moreover, simple tasks such as food preparation, bathing and clothing the elderly who are sick also fall on the shoulder of the younger women. Conflicts are common between the two generations, especially in cases when the elderly feel they are being neglected or have differences in opinion regarding how children should be raised.

In other cases, the elderly live alone, either because most of their children have moved outside the camp and/or because the shelter of their son is too small, his family is too large or he does not have the financial means to accommodate his parents. In this case the parents are able to maintain their own place, but again, the main problem is neglect. Field visits indicated that the shelters of the elderly are in bad need of renovation and reconstruction and cases have been sited when the roofs simply fell in on the heads of the elderly. In the past, UNRWA was able to extend its shelter rehabilitation program beyond those enrolled in the Special Hardship Case program. The elderly are not identified as a priority segment by UNRWA as are the disabled, women and youth. Therefore, programs geared to the elderly are diminishing. In some camps, the local mosque provides two hot meals per week to the elderly who have no one to look after them.

Incest is a problem that occurs more often than is publicly acknowledged. The crowded houses where growing brothers and sisters sleep next to one another and in most cases, parents with children in the room, leads to incest. Both women and men during one-on-one interviews confirmed that the problem of incest is not uncommon, but did not wish to discuss the issue in public or in larger groups. In a few cases, these problems became public knowledge.

Incest that occurs between family members is silenced and it is almost impossible to evaluate its effect on girls especially, since they would never dare discuss it with any adults, men or women. Even community leaders suggested in some interviews that incest is an issue that should not be publicized, because it often backfires on the victims of incest, usually young girls and sometimes boys. In some cases, the victim becomes the ‘sinner.’

It is apparent there is a direct relationship between incest and overcrowding. Even adults would describe how when they were younger they slept all in a row like ‘sardines’ sometimes ten of them. In addition, it is quite common for children to sleep in the parent’s room and for babies to sleep next to the parents. Older men and women would disclose that the used to ‘hear’ or ‘see’ what ‘went on between their parents.’ There is a marked contradiction between public taboos on sexuality and the personal and private experiences of people in terms of what they have learned and experienced as children about sexual practices and sexuality. One young man noted ‘I learned everything there is to know about it in the camp, from my parents, my brothers and sisters, when we played as boys together in the cemetery near the camp and behind trees!’

Most importantly, it is important to activate the community-based organizations. However, initial material, financial and logistical support is needed, especially at a time when there are severe cutbacks in UNRWA affecting the refugee community as a whole. Short-term investment in the activation and support of the community to alleviate problems associated with overcrowding, will in the long run assist them to become self-supporting and autonomous.

Training in human-resource planning and managing local organizations is important. It is therefore recommended that community leadership be fostered, especially from among the youth, providing them with training in managing, planning and implementing programs. Most importantly, it is necessary to provide training in community mobilization and encourage volunteer activities.

Most of the refugee camps in the West Bank and Gaza have universal needs that will mitigate the effects of overcrowding. However, there are also specific needs which must be taken into consideration when implementing projects. These specific projects may be based on the following list of recommendation and priorities which are the sum total of the major and most urgent problems resulting from overcrowding.

The social and psychological effects of overcrowding is exacerbated by the low standards of the infrastructure in camps. In addition to the pressures brought about by spatial density in the camp and overcrowding within shelters, the environmental factor is depressing and demoralizing. In most camps the smell of dirty water leaking from open drainage and sewer pipes permeates the air and is compounded by the smell of uncollected garbage bins. In some camps sewer drainage systems or networks have not been extended. In many alleyways in refugee camps, it is difficult to walk through, without having to step into the dirty water or a hole. This environment is the larger "playground" for refugees and especially children who spend most of their childhood in the streets, usually for lack of proper playgrounds and centers. Consequently, it is not surprising that refugees point out that this is an urgent need for improvements in the overall infrastructure of the camps. Such improvements, should include the asphalting of streets, which turn into mud pools in the winter, as is the case in Jabalia camp.

An urgent priority that cuts across all camps is shelter renovation, reconstruction and expansion of housing units. By November last year, UNRWA’s Self-Help approach to shelter rehabilitation was responsible for the rehabilitation of 60% of shelters for those enrolled in the Special Hardship program. If one considers that the SHC covers approximately 6% of the total refugee population, it becomes clear that the number of people who were able to get help is minimal relative to the needs. In addition, the regulations surrounding who is eligible for the SHC program is extremely stringent, leaving out many needy families who are unable to afford the rehabilitation of shelters. Nevertheless, the example of UNRWA’s approach is a good one to emulate. The Self-Help project provides a participatory role to refugees, involving them in decisions regarding the design, leaving the responsibility of the actual reconstruction or renovation to them, and providing three installments, while following up on the various stages in the reconstruction.

Table 6: Registered Refugees Recorded as Special Hardship Cases in the WB and Gaza

Year	Gaza	West Bank
1999*	70,628	29,375
1994	59,888	30,585
1990	44,603	26,769
1988	38,605	22,412

The percentage of SHC for the same year are: Jordan, 19.40%, Gaza, 34.40%, S.A.R. 12.20%, Lebanon, 19.69%, West Bank, 14.31%

The percentage of SHCs to Registered Refugee Population as of Nov. 1999 are: Gaza, 8.7%, WB, 5.1%, Lebanon, 10.8%, S.A.R. 6.6%, Jordan, 2.6%. The average is 5.6%

Many of the UNRWA schools run on a double shift and in 1999, the Agency began to build new schools and maintaining others, especially in Gaza, where the average class size fifty pupils per classroom. Yet, in view of shrinking budgets, these efforts despite their significance are insufficient and both the West Bank and Gaza are in need of more schools to lower the numbers in classes. However, there are short-term projects which may enhance the school environment, such as renovations on existing schools and the building of extra classrooms. Pupils also suffer in that many of these schools have small playgrounds which are congested with students at break time. There are also no spaces for extra-curricular activities, libraries are too small and books are few and old, in some there are no libraries at all.

There is a need to provide counselling services to students who simply do not have anyone to turn to for academic support or to counsel them. There are many students in higher preparatory grades who do badly in school and special education programs will be of tremendous help. Also important are programs upgrading the skills of teachers in new methods of teaching.

In this area, it is important to provide financial and logistical support to health centers. In many camps there is only one center serving thousands of people, usually the camp population and surrounding area. Secondly, the health staff are overworked. Doctors as mentioned earlier sometimes have to see 150 patients per day and many patients return home without being seen. Due to the pressure on the health centers in camps, many refugees are compelled to seek private health care adding to their financial burdens. Therefore, it is important to find ways to increase the medical staff.

In addition, female doctors are few and many women avoid male doctors. Hence, there is a need for female specialists, especially in women’s health issues, such as childbearing, gynecology, psychologists and psychiatrists.

Clinical psychologists are very few in the camps. Women and youth are especially in need of counselling. Some of the women interviewed revealed they were taking anti-depressants, but usually there are many social problems left unattended and the anti-depressents do not solve their problems at home and in the community. In Shu’fat camp, a special emphasis was placed on counseling centers since many youth are addicted to smoking, drugs such as ‘bango’ and hashish. Some of the youth after the Intifada turned to drugs and other forms of addiction. Finally, specialists in caring for the disabled are very few and many of the volunteers have no skills or training in this area.

The absence of playgrounds for children is a real problem in all camps. In earlier decades and before concrete totally replaced gardens and filled the available spaces in refugee camps, children played in front of their homes. On the one hand, the little gardens or spaces provided an outlet for families living in shelters, relieving the stress inside the shelters and on the other hand, it offered children a place to play more safely under the scrutiny of parents and neighbors.

Playgrounds are a priority cited by all those interviewed and in all camps. The main problem is that in many camps the space is simply unavailable or limited. Creative solutions are required to find the best way to create play centers for children. In larger camps, more than one play area/playground/park is needed. Although spaces are limited, such as in Camp No. 1, alternatives are possible around camps, if not within them.

Adolescent girls and boys suffer from being at an age when they are neither ‘children’ nor ‘youth’ in official and international definitions. Adolescent girls, especially, do not have any places to go and the concept of ‘entertainment’ is simply absent or restricted to visits with relatives and television. Many of them do not leave the camp boundaries, except on rare occasions. Ten or twelve year-old girls cannot play in the streets like their brothers and neither can they join in the women’s centers providing various programs. This age group complains that all they do is stay home and watch over their younger siblings. It is therefore, imperative that ‘girls’ clubs providing indoor sports, social and cultural activities be established. Similarly boys in this age group need such centers. When many adolescents are facing problems in schools, such clubs or centers could provide assistance and counseling for slow-learners. This would encourage many parents to allow their daughters to participate.

The interviews showed that youth, who constitute a large percentage of the population, are stereotyped as a ‘dangerous’ and ‘uncontrolled’ segment of society. With low educational standards at school, limited spaces and centers to enhance their potential, they feel lost and neglected. Therefore, it is important that programs and centers catering to their needs should be established. These should include extra-curricular activities ranging from sports to computer training as well as cultural and social activities, including art, theater and music. Some of the UNRWA community based youth centers are beginning to include young women. However, these are too few and the social and cultural environment in most camps does not encourage such mixed centers. Therefore, centers exclusively for women are needed.

Many young women who may be categorized as ‘youth’ are also married. It is not uncommon to meet women at 18 or 19 with two or three children. Therefore, programs for young women should integrate assistance in providing child-care and awareness raising programs on family planning and health issues. The lack of these spaces also forces the younger generation in seeking alternative ways to express their potential and identity. Many students who do not do well in school, could greatly benefit from such centers that provide group solidarity. On the social level, cultural and social clubs provide an outlet and an avenue for personal growth and development.

Programs directed at raising awareness of women’s rights are important, however, some of these programs have failed in the past because they did not take into consideration the conservative environment which exists in many camps. Therefore, these issues could be introduced within larger programs such as ‘family planning’, legal counseling and general health as the overall framework and within that provide awareness on gender issues, physical and psychological abuse, child rearing and skills training. Middle-aged and older women, especially those who are not working, comment that there are no places for them to go. The women’s centers capacity is limited and therefore it is recommended that the women’s centers be expanded.

More importantly, it is important to establish networks that will reach women in their homes, as there are many who cannot leave their homes for various reasons. Some of these women suffer from depression, abuse or health problems and they remain without support, because they cannot reach the center. Thus an approach which aims at reaching out towards the community will be more successful than expecting the community to reach to the center, at least until the centers are well established.

There is a need to provide community awareness programs, directed at the family as a whole. Many women for example, point out that it is the men who need education on the problems they face as women in the family and society. Men point out that women do not understand the pressure placed upon them to be the primary providers for extended families. Therefore, it is important to include programs directed at the family as a whole and in relation to the local community, its needs and problems.

Issues such as incest, rape, addiction and sexual disease are generally taboo and remain hidden in private domains. Often individuals suffer alone with nowhere to go for assistance or counseling. Health centers are one avenue that could provide such counseling. These issues are very important to tackle and occur more frequently than is publicly acknowledged. Methods such as a public survey do not reveal these carefully hidden problems.

Therefore, problems such as incest should be dealt with sensitively and in consultation with local community leaders, especially women’s organizations and health care staff. Special channels and means of reaching these individuals must be developed, for example, hotlines, counselors, clinical psychologists and so on.

Poverty and overcrowding are in most cases interlinked. In addition to providing support in shelter rehabilitation, it is important to implement projects that target poorer families to help them become economically independent. These may include both family-run businesses and enterprises that create employment. The poverty alleviation schemes should be based on a thorough needs assessment and economic viability of projects, whether they are income-generating projects or micro-enterprises and/or loans/grants schemes.

Also, job-placement programs that help youth and skilled refugees could be developed. A suggestion from the field was that income generating projects are needed, because they might ‘entice the youth’ to stay within the community and therefore continue their education. It is important to provide awareness programs on the significance of education for both boys and girls.

The primary problem with existing services and organizations is that these are insufficient and in many cases ineffective. A small percentage of the community benefits from many of the available services. Moreover, many of the programs are targeted at one segment of the community and the family as a unit, for example, is neglected. This latter issue is significant, in that in Palestinian society the family is the basic unit of society and the individual is closely entangled in family relations. There is also overlap in services due to lack of coordination by the local and international organizations providing services in camps. In some cases, the programs are not based on local priorities and identified needs, but respond more to international and donor prerogatives and priorities.

There are numerous local community organizations, however, many of these are ineffective and need support, both in terms of training in skills and management and materially in terms of equipment and funding.

Overlapping services is another problem and this often means that one problem area is covered by more than one organization, while other areas are neglected. Consequently, training in human resource development and planning is important, especially for employees and volunteers working in local committees.

Another recommendation is the creation of committees representing all community-based organizations within refugee camps to continuously identify and prioritize problems; to plan, coordinate and implement programs and projects aimed at the community as a whole.

Another priority area is to upgrade the knowledge and skills of employees and volunteers, such as care for the disabled; seminars and courses for trainers and to develop local leadership skills.

It is important to provide logistical, material and financial support for short-term projects that will help mitigate problems associated with overcrowding. However, it is equally important to simultaneously support projects which empower the community, by providing training and logistical support to the community organizations who will eventually be able to tackle the problems associated with overcrowding more efficiently. Finally, while short-term projects may help mitigate and solve some of the issues related to overcrowding, the political issues and general poverty are two major factors which continue to reproduce overcrowding in refugee camps.

Name of Camp	District Zone*	Area in dunums*	Year of Establishment	Population upon Establishment	Population in 1999
Camp No. 1	Nablus A	45	1950	?	5,678
Shu’fat	Jerusalem C	203	1965	?	8,864
Kalandia*	Jerusalem C	353	1949	3,000	7,964
Jalazone	Ramallah B	253	1949	3,500	8,040
Dheisheh	Bethlehem A	430	1949	?	9,624
Jabalia	Gaza A	1,435	1954	35,000	97,895